For B.C. patient, last-minute surgery cancellation raises fears of cancer spread

Open this photo in gallery:

Geneva Reynen had never been known to cry, but in a Vancouver hospital room last week she sobbed until she couldn’t breathe.

Four months earlier, the former care aide had been diagnosed with Stage 3 ovarian cancer – a devastating diagnosis that finally explained the swelling stomach and accompanying pain she had been experiencing then for nearly a year.

Last week, Ms. Reynen was scheduled to have surgery to remove a large tumour and tissue to which the cancer had spread. But, minutes before the operation was scheduled to take place, it was cancelled – a consequence of a cancer system that insiders say is operating at capacity.

Ms. Reynen pulled her blanket over her face after her doctor delivered the news.

“I never cried once when I was told I had cancer. But that day, I did,” Ms. Reynen, 60, said in an interview. “I got mad, I cried, I did everything to get it out, because I just thought, ‘I’m going to die. It’s going to spread.’”

The Globe and Mail has been reporting on the pressures in British Columbia’s cancer-care system, where insiders blame bureaucracy, poor long-term planning, staffing shortages and cascading delays for pushing wait times for treatment in many cases from weeks to months. Gynecologic cancer cases have been particularly affected.

A shortage of gynecologic oncologists, nurses and operating room time have contributed to a backlog. Patients who would ideally be operated on within two weeks are currently waiting up to 10.

Access is another issue. B.C. has only eight gynecologic oncologists – six in Vancouver and two in Victoria – meaning anyone on the mainland requiring such a specialist must travel to Vancouver, where every gynecologic cancer patient is currently treated beyond their target window of time. Those targets vary with the severity of the disease.

And, since early November, local health authorities have been transitioning from paper chart records to an electronic system – an overdue modernization of medical records that nevertheless is happening at an inopportune time. Complications from the changeover have contributed to the cancellation of about one-third of gynecologic cancer surgeries through the rest of the year, as staff undergo training.

Ms. Reynen encountered all of the above. Shortly after her diagnosis in August, she began chemotherapy and was scheduled for surgery on Dec. 15. That morning, her family drove from Chilliwack to Vancouver and registered at Vancouver General Hospital, where Ms. Reynen put on a gown and was hooked up to an IV.

But the reduction in surgical capacity, combined with an overflow of intensive-care unit patients into the hospital’s recovery room, meant her surgery couldn’t proceed.

Justin McGinnis, her gynecologic oncologist, delivered the news.

“I probably spent 20 minutes with her and the family explaining that this is not what any of us wanted, and that we’re going to work hard to find another date for her as soon as possible,” he recalled in an interview. “We spent some time talking about her symptoms, and if I could prescribe any new pain medicines to help in the meantime as we await a new date.”

Having to deliver such news makes Dr. McGinnis think about its psychological impact.

“I think about the stress that’s associated with preparing for a major surgery. From a patient’s perspective, that’s a very stressful event – probably one of the most defining events in their entire health care experience,” he said. “I think a lot, too, about how many of our patients are very stoic – they understand that there are capacity limitations – but it’s still hard for them to rationalize what’s going to happen next.”

Ms. Reynen said Dr. McGinnis looked heartbroken. “You could see it was devastating to him,” she said. “He says, ‘I am so sorry, but we can’t do your surgery.’ I thought he was joking. I said, ‘You can’t be serious.’ And he said, ‘I am so sorry.’”

After a November report in The Globe on gynecologic cancer wait times, Vancouver Coastal Health officials met with surgeons and allocated more operating room time for those surgeries.

By rescheduling a combination of unassigned time and extra time allotted for other services, the gynecologic oncology service at Vancouver General Hospital will have 21 additional operating days between Jan. 3 and March 10, equal to about 20 additional surgery hours per week. Leaders at the hospital also committed to advocating for the expansion of gynecologic oncology services to other health authorities.

Sarah Finlayson, the division head of gynecologic oncology at the University of British Columbia and the gynecologic oncology representative at BC Cancer, the province’s cancer agency, said the increase is welcomed and needed, but that it is far from the substantive fix needed to alleviate pressures on the system. B.C. has the lowest ratio of gynecologic cancer surgeons to its population of any province in Canada. Adding cancer surgeons in other regions of the province is essential for excellent, timely care, she said.

“VGH senior leadership has been very supportive in working to solve this problem, but what has become very clear is that VGH alone cannot serve the urgent cancer needs of all women with gynecologic cancers,” Dr. Finlayson said. “There is urgent need for additional centres in Interior Health and Fraser Health,” which serve other parts of B.C.

In a statement to The Globe, B.C.’s Ministry of Health said the province has invested an additional $41-million in cancer care this fiscal year, and $25-million last fiscal year, allowing for 70.25 new full-time equivalent physician roles at BC Cancer since 2021. This includes 1.4 full-time equivalent salaries for two new gynecologic oncologist positions, for which BC Cancer is actively recruiting – one in Vancouver and one in Victoria.

But there are no plans to expand gynecologic oncology services outside of those two cities.

“Since BC Cancer is a provincial system, subspecialists are not located in each regional cancer centre,” the statement said. “This is similar to the distribution of subspecialists within other provinces; they are often located in more population-dense areas where there is higher demand.”

The ministry acknowledged that many British Columbians live outside of urban centres. It said assistance with transportation and lodging associated with cancer treatment may be available for patients and their families through the province’s transportation assistance program, or through other agencies.

“Our government has made strategic investments to improve access and quality of cancer care in B.C., but we know more work needs to be done,” the statement said. “The Ministry of Health, Provincial Health Services Authority and regional health authorities continue to work collaboratively with BC Cancer on a 10-year cancer action plan, which we expect to release in the next year.”

Ms. Reynen’s surgery was initially rescheduled for February, then moved up to early January. In the meantime, she is experiencing physical pain, mental fogginess from her chemotherapy and anxiety from the delay and uncertainty. Her husband, four children and five grandchildren continue to support her, advocating for her where they can. Unbearable pain this week, which she described to a family member as the worst in her life, sent her back to her local hospital.

“I’m scared that the cancer is going to spread more,” she said. “I think it is; I can feel it. Three weeks – is it going to grow? I don’t know. I’m just scared. I’m scared for my family, because my family just loves me so much.”